Lung recruitment using oxygenation during open lung high-frequency ventilation in preterm infants

Area of Science:

• Neonatal Medicine
• Pediatric Respiratory Medicine
• Critical Care

Background:

• Oxygenation monitoring guides recruitment in preterm infants during open lung high-frequency ventilation.
• Limited data exist on the clinical feasibility and safety of this approach.

Purpose of the Study:

• To prospectively gather data on ventilator settings, gas exchange, and circulatory parameters.
• To evaluate these parameters before and after surfactant therapy during open lung high-frequency ventilation.

Main Methods:

• Recruitment pressures (opening, closing, optimal) were determined in 103 preterm infants with respiratory distress syndrome.
• Optimal recruitment was defined as adequate oxygenation with FiO2 ≤ 0.25.
• The procedure was repeated after each surfactant treatment.

Main Results:

• Mean presurfactant optimal pressure was 14.0 cm H2O (FiO2 0.24).
• Surfactant therapy reduced optimal pressure by ~6 cm H2O without compromising oxygenation.
• Hemodynamic stability and no air leaks were observed; mortality and morbidity were comparable to prior studies.

Conclusions:

• Open lung high-frequency ventilation guided by oxygenation is feasible and safe in preterm infants.
• This method allows for a reduction in the fraction of inspired oxygen (FiO2) below 0.25 in most infants.
• It supports effective respiratory support in neonatal respiratory distress syndrome.